“Systems And Methods Providing Medical Privileging And Data Over Data Networks Using A Distributed Ledger” in Patent Application Approval Process (USPTO 20230019862): Patent Application

2023 FEB 02 (NewsRx) -- By a News Reporter-Staff News Editor at Insurance Daily News -- A patent application by the inventor VINES, JENNIFER HARRELL (Dallas, TX, US), filed on March 3, 2022, was made available online on January 19, 2023, according to news reporting originating from Washington, D.C., by NewsRx correspondents.

This patent application has not been assigned to a company or institution.

The following quote was obtained by the news editors from the background information supplied by the inventors: “The U.S. Department of Health and Human Services’ definition of credentialing is “the process of assessing and confirming the qualifications of a licensed or certified health care practitioner.” Credentialing is an essential process that healthcare organizations and practices must perform to ensure those providing medical services are qualified to do so.

“The process has become more complicated over time due to the expansion of providers’ scopes of service, the requirements of third-party payers (e.g., the U.S. government and private health insurance plans), and organizational standards (accrediting bodies).

“The companion piece to credentialing is “privileging”, which is the process of authorizing a licensed or certified medical service provider’s specific scope of patient care services. Privileging is performed in conjunction with an evaluation of an individual’s clinical qualifications and/or performance.

“In the past, credentialing and privileging were mainly associated with hospitals. Now, these processes are being required at healthcare facilities, ambulatory surgical centers, and long-term care organizations (collectively “healthcare organizations”). Credentialing and verifying also applies broadly to other industries as well as credit granting processes at financial institutions.

“Healthcare organizations are responsible for validating the competency of their medical staff through credentialing and privileging. These processes are closely tied to reimbursement, accreditation standards, and state and federal laws. Although credentials and privileges will vary among medical service providers (depending on their backgrounds, qualifications, areas of practice, and practice settings), having detailed and consistent credentialing and privileging processes is imperative.

“The healthcare organizations privileging process has been dysfunctional and extremely time consuming. Many hospitals continue to use paper applications while constantly receiving incomplete submission files that delay their ability to hire a provider. Currently, medical service providers who are applying for privileging at a hospital must print multiple applications and forms to be completed and returned. In addition, all medical school and licensing verification is also completed via paper forms. All the paper documents are either saved in physical file folders or scanned and saved to management software. The process is scattered, not uniform and time consuming.

“The client health system has recognized that the way its credentialing activities are currently being carried out across its system does not consistently achieve the level of quality, timeliness, efficiency, high reliability, uniformity and value needed to succeed in today’s environment. Specific challenges include: inconsistency and lack of standardization with credentialing and privileging processes; lengthy turnaround times for the initial appointment process; and lack of medical service provider satisfaction with the credentialing and privileging process.

“Centralized credentialing can resolve some of the complexities of credentialing and privileging, however the unique nuances of each healthcare organization’s bylaws and how they impact the delineation of privileges seems to be a barrier to such a product/service existing up to now (as the bylaws would need to be standardized across participating healthcare organizations). What is needed are systems and methods to streamline the healthcare organizations privileging process, decreases the time required to apply for privileges, control access and access levels to information, and reduces administrative costs for healthcare organizations.”

In addition to the background information obtained for this patent application, NewsRx journalists also obtained the inventor’s summary information for this patent application: “The following summary is provided to facilitate an understanding of some of the innovative features unique to the disclosed embodiments and is not intended to be a full description. A full appreciation of the various aspects of the embodiments disclosed herein can be gained by taking the entire specification, claims, drawings, and abstract.

“It is a feature of the present embodiments to provide access to a platform wherein users such as medical service providers (e.g., medical doctors) are not just filling in an application for credentialing, but where they can also manage and secure their data. It is another feature of the present embodiments to enable users with more interaction with a credentialing system and with data recipients such as healthcare organizations (e.g., hospitals) through a credentialing system.

“It is a feature of the present embodiments to overcome the current problems associated with professional credentialing and privilege management (i.e., healthcare institution access). It is a feature of the embodiments to provide a network accessible application for the healthcare organizations privileging process that can leverage any combination of artificial intelligence, computer assets, cloud-based assets, and distributed ledgers to enable medical service provider data storage and security as well as control over providing access to select data by healthcare organizations and select third parties.

“In accordance with features of the embodiments, with a centralized system users can remotely access systems containing credentialing and managing privileges for medical service providers using their electronic clients (e.g., desktops computers, tablets, smartphones).

“In accordance with an example embodiment, a network accessible server can be provided that is configured to register users, collect data, process data, authorize access to the exchange or provision of data to requesting users and essentially streamline the privilege management process.

“For healthcare organizations like hospitals, features of the embodiments can enable healthcare organizations to:

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“Eliminate paper applications and forms

“Retrieve and download application files of medical service providers

“Efficiently utilize centralized credentialing and privileging systems for initial and renewal privileging

“First source verifies references

“Gain easy access licensing documentation.

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“For medical service providers such as medical doctors, features of the embodiments can enable them to:

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“Enter application information once, which can be saved for future use

“Eliminate the need for repetitive record retrieval from former employers, licensing agencies, medical schools

“Enable worldwide access to data

“Enable single contact and verification of references, with reference information being saved in a medical provider profile

“Provide an economically feasible profile management and access from cloud-based or distributed ledger platforms under the appearance of a centralized platform.

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“It is another feature that, during registration, a medical service provider can initially set up a user account and profile including completing a single application that is a compilation of numerous application fields from a variety of healthcare organizations. The application can be saved to the medical service provider’s profile in any of a remote server (e.g., the service cloud) or a distributed ledger. In addition, the medical service providers can request references from others either by searching and locating someone who is currently using the service, or by sending an email that allows them access to the service. The references can complete a single reference form online and that can be saved to the medical service provider’s profile. The medical service provider can also have the ability to upload medical school documentation, licensing verification or certification verification. These documents can be securely saved to the medical service provider’s profile. When the profile is complete, medical service providers can search for healthcare organizations to select for receiving their privileging application. The healthcare organizations’ privileging fee can be charged via the credentialing platform to the medical service provider, along with a nominal fee per application. Furthermore, medical service providers can have the opportunity to maintain their privileges profile for a monthly maintenance fee. This information can remain accessible to them while allowing for additional information to be uploaded. Future privileging applications can be submitted via the service.

“In accordance with features of the present embodiments, healthcare organizations can more efficiently process new and renewal privileging applications via the system. Healthcare organizations can have user credentials with which to access a dashboard. This dashboard can provide a page on which to choose fields from the general application that meet their needs. Healthcare organizations can be alerted to privileging applications for their institution and can view the medical service provider’s profile, application, and documents. The healthcare organization can then have the ability to categorize each applicant based on the action taken. Healthcare organizations can choose whether to maintain their applicant information in the service cloud or distributed ledger, or to download it to their own information management systems.

“In accordance with features of the present embodiments, references can be requested via the medical service provider, but an additional level of security can be provided to ensure first source verification. References can utilize a link to access their dashboard, and once a profile is created, a verification code can be emailed. This code can be required to log-in and continue to the reference form. The referral form can be completed once and electronically signed, then uploaded to the medical service provider’s profile.

“In accordance with additional features of the embodiments, time saving features enable healthcare providers to complete and attest to multiple state credentialing applications in one intelligent workflow design, upload supporting documents directly into a database to eliminate the need for manual submission and to improve the timeliness of completed applications, review and approve information before data is imported, protect against delays in data processing with more focused prompts and real-time validation, and enable self-registration with the system before a health plan initiates the application process.

“In accordance with additional features of the embodiments, a system can be provided for credentialing and privilege processing, management, control, and data exchange for authorized users that includes a server accessible from clients over a data network, the server providing centralized credentialing forms to service providers and adapted for receiving supplemental information in association with service provider applications associated with a service provider, an artificial intelligence (AI) module configuring the server to process input and data provided from at least one of a service provider and third party sources on behalf of the service provider, wherein the AI module can populate credentialing forms and an access level to one or more data portion of records and forms associated with the service provider by reviewing parties, and access to a blockchain network. The blockchain network can be adapted to authenticate and grant access to the records and forms associated with the service provider to organizations authorized by the service provider to access and provide records in support of the service provider application for privileges, and thereby access the records after a log-in to the server by the organizations.

“In accordance with additional features of the embodiments, one or more non-transitory computer readable media can be provided having program instructions stored thereon which, when executed by at least one processor, cause a machine to: receive a request to view one or more access-controlled data portions of a blockchain entry representing service provider data in support of credentialing; identify the one or more data portions, and an access level set by a data provider, associated with the request; and generate a customized view of any of the one or more data portions according to the access level. When executed by the at least one processor, the program instructions can further cause the machine to apply at least one redaction to any of the one or more data portions not associated with the access level. When executed by the at least one processor to receive the request, the program instructions further cause the machine to receive data representative of an access code associated with the request. The data representative of the access code includes at least one of: a pin code, a password, a fingerprint, a barcode, a retinal scan, a token, a questionnaire, and a multi-factor security authenticator. When executed by the at least one processor, the program instructions further cause the machine to validate access to view the one or more data portions based on the access level, and wherein when executed by the at least one processor to generate the customized view, the program instructions further cause the machine to generate the customized view in response to the access being validated. When executed by the at least one processor, the program instructions further cause the machine to evaluate the access level to determine the any of the one or more data portions accessible by the request, and wherein when executed by the at least one processor to generate the customized view, the program instructions further cause the machine to generate the customized view in response to the access level being evaluated.”

There is additional summary information. Please visit full patent to read further.”

The claims supplied by the inventors are:

“1. A system for providing credentialing and privilege processing, management, control, and data exchange for authorized users, comprising: a server accessible from clients over a data network, the server providing centralized credentialing forms to service providers and adapted for receiving supplemental information in association with service provider applications associated with a service provider; an artificial intelligence (AI) module configuring the server to process input and data provided from at least one of a service provider and third party sources on behalf of the service provider, wherein the AI module can populate credentialing forms and an access level to one or more data portion of records and forms associated with the service provider by reviewing parties; access to a blockchain network adapted to: authenticate and grant access to the records and forms associated with the service provider to organizations authorized by the service provider to access and provide records in support of the service provider application for privileges, and thereby access the records after a log-in to the server by the organizations.

“2. The system of claim 1, wherein the blockchain network is configured by the server to: receive a signal encoding data representative of a request to view the one or more data portions of a blockchain entry that are access-controlled; identify the one or more data portions, and an access level, associated with the request; validate access to view the one or more data portions based on the access level; generate a customized view of any of the one or more data portions according to the access level; and cause the customized view to be displayed via a user device in response to the validating the access.

“3. One or more non-transitory computer readable media having program instructions stored thereon which, when executed by at least one processor, cause a machine to: receive a request to view one or more access-controlled data portions of a blockchain entry representing service provider data in support of credentialing; identify the one or more data portions, and an access level set by a data provider, associated with the request; and generate a customized view of any of the one or more data portions according to the access level.

“4. The one or more non-transitory computer readable media of claim 3, wherein when executed by the at least one processor, the program instructions further cause the machine to apply at least one redaction to any of the one or more data portions not associated with the access level.

“5. The one or more non-transitory computer readable media of claim 3, wherein when executed by the at least one processor to receive the request, the program instructions further cause the machine to receive data representative of an access code associated with the request.

“6. The one or more non-transitory computer readable media of claim 5, wherein the data representative of the access code includes at least one of: a pin code, a password, a fingerprint, a barcode, a retinal scan, a token, a questionnaire, and a multi-factor security authenticator.

“7. The one or more non-transitory computer readable media of claim 3, wherein when executed by the at least one processor, the program instructions further cause the machine to validate access to view the one or more data portions based on the access level, and wherein when executed by the at least one processor to generate the customized view, the program instructions further cause the machine to generate the customized view in response to the access being validated.

“8. The one or more non-transitory computer readable media of claim 3, wherein when executed by the at least one processor, the program instructions further cause the machine to evaluate the access level to determine the any of the one or more data portions accessible by the request, and wherein when executed by the at least one processor to generate the customized view, the program instructions further cause the machine to generate the customized view in response to the access level being evaluated.

“9. A method for providing credentialing and privilege processing, management, control, and exchanges of data for authorized users, comprising: providing a server accessible from clients over a data network, the server providing centralized credentialing forms to service providers and adapted for receiving supplemental information in association with service provider applications associated with a service provider; providing an artificial intelligence (AI) module configuring the server to process input and data provided from at least one of a service provider and third party sources on behalf of the service provider, wherein the AI module can populate credentialing forms and an access level to one or more data portion of records and forms associated with the service provider by reviewing parties; providing access to a blockchain network configured to: authenticate and grant access to the records and forms associated with the service provider to an organization authorized by the service provider to access and provide records in support of the service provider application for privileges, and thereby access after a log-in to the server, to the organization.

“10. The method of claim 9, wherein the blockchain network is further configured by the server to: receive a signal encoding data representative of a request to view the one or more data portions of a blockchain entry that are access-controlled; identify the one or more data portions, and an access level, associated with the request; validate access to view the one or more data portions based on the access level; generate a customized view of any of the one or more data portions according to the access level; and cause the customized view to be displayed via a user device in response to the validating the access.

“11. The method of claim 9, wherein authenticating and granting access to records and forms associated with the service provider, further comprises registering the service provider with a centralized credentialing and privilege/management administration system associated with the server, in response to a user input.

“12. The method of claim 11, wherein the registering of the service provider further comprises: electronically setting up a personal profile; electronically filling out at least one medical provider application among the service provider applications; uploading credential documents; and identifying references.

“13. The method of claim 12, wherein the credential documents include at least one of: a college degree or a license.

“14. The method of claim 12, wherein the references include peer references.

“15. The method of claim 9, wherein the server further provides monitoring of a status of at least one service provider application among the service provider applications when the service provider has logged into the server and after the registering is complete.

“16. The method of claim 9, wherein: the authenticating and granting of access to the records and forms associated with the service provider, further comprises: registering the service provider with a centralized credentialing and privilege/management administration system associated with the server, in response to a user input; the registering of the service provider further comprises: electronically setting up a personal profile; electronically filling out at least one service provider application among the service provider applications; uploading credential documents; and identifying references.

“17. The system of claim 16, wherein the credential documents include at least one of: a college degree or a license.

“18. The system of claim 16, wherein the references include peer references.

“19. The system of claim 10, wherein third parties comprising the hospitals and third party institutions include credentialing agents.

“20. The system of claim 19, wherein the server is operable to allow the credentialing agents to send and/or receive text messages from the organizations and third party institutions.”

URL and more information on this patent application, see: VINES, JENNIFER HARRELL. Systems And Methods Providing Medical Privileging And Data Over Data Networks Using A Distributed Ledger. U.S. Patent Application Number 20230019862, filed March 3, 2022 and posted January 19, 2023. Patent URL (for desktop use only): https://ppubs.uspto.gov/pubwebapp/external.html?q=(20230019862)&db=US-PGPUB&type=ids

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